Individual
HEATHER NICOLE KNUTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1605 E RIVERSIDE DRIVE, EAGLE, ID 83616-6237
(208) 939-6227
(208) 939-6442
Mailing address
1605 E RIVERSIDE DRIVE, EAGLE, ID 83616-6237
(208) 939-6227
(208) 939-6442
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
NP672A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP 672A
NP LICENSE
ID
01
—
P00748833
RAILROAD MEDICARE 08/01/09
ID
Enumeration date
07/14/2005
Last updated
11/03/2022
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